Heart Failure Treatment with Entresto: How Long Should You Take It?

Entresto (sacubitril/valsartan) is generally recommended for long-term use in the management of heart failure. As a combination of an angiotensin receptor blocker and a neprilysin inhibitor, it works by improving ventricular remodeling, reducing the breakdown of brain natriuretic peptide, and providing diuretic, vasodilatory effects. These actions help reverse structural heart changes and improve overall patient outcomes. Because of these beneficial effects, most patients are advised to continue treatment indefinitely, under the supervision of a healthcare provider.

Monitoring During Long-Term Entresto Therapy

While Entresto is effective in managing heart failure, long-term use requires careful monitoring for certain health parameters to ensure safety and efficacy. Patients should be regularly evaluated for the following conditions:

1. Blood Pressure Levels

Low blood pressure (hypotension) can be a concern during treatment. If a patient's systolic blood pressure drops below 90 mmHg or symptoms such as dizziness, fatigue, or lightheadedness occur, it may be necessary to temporarily discontinue Entresto. Blood pressure should be stabilized before resuming therapy, and any changes should be made under medical supervision.

2. Kidney Function

Monitoring kidney function is crucial while on Entresto. If a patient experiences a significant decline in glomerular filtration rate (GFR)—such as a drop below 30% or a reduction of more than 50% from baseline—treatment should be paused. In such cases, alternative therapies may be considered, and kidney function should be closely followed before restarting the medication.

3. Cardiac Function Improvements

In some rare cases, particularly among patients with acute severe myocarditis, treatment with Entresto can lead to a full recovery of heart function, including normalization of ejection fraction and cardiac structure. In these situations, discontinuation of Entresto may be considered cautiously, followed by regular follow-ups to monitor for any signs of recurrence.

When to Restart or Continue Entresto

If heart function deteriorates again after stopping the medication, Entresto should be restarted promptly. For many patients, this may mean lifelong therapy is necessary to maintain heart function and prevent hospitalizations. Close collaboration with a cardiologist ensures that treatment is tailored to each individual's needs and adjusted as necessary over time.